UTERO–VAGINAL PROLAPSE

Definition

,, Form of hernia that implies a descent of the uterus and /or the vagine ’’

Clinical forms

Vaginal prolapse of the anterior wall

- CYSTOCELE

- URETHROCELE

Vaginal prolapse of the posterior wall - ENTEROCELE

- RECTOCELE

Uterovaginal prolapse – represent the descent of the uterus, always accompanied by some descent of the upper vagina.

UTERO–VAGINAL PROLAPSE

UTERO–VAGINAL PROLAPSE

UTERO–VAGINAL PROLAPSE

Uterovaginal prolapse – 3 degree

First degree – when there is a slight descent of the uterus but the cervix remains within vagina

Second degree – the cervix projects beyond the vulva, when the patient strains

Third degree ( Complete Procidenta) – the entire uterus has prolapsed outside the vulva and most or all of the vagina is everted.

UTERO–VAGINAL PROLAPSE

Etiology

Anatomical considerations

Functional considerations:- Constitutional factor ( the imperfect

development of the supporting tissues)- Gestational factor- Endocrine factor- Mechanical factor ( tumoral or pelvic

inflammatory diseases)

Symptoms

’’ Something falling out ’’

Pelvic pains

Difficulty or discomfort in micturition or defaecation

Backache

Bleeding or vaginal discharge

Diagnosis

Inspection of the vulva- when the patient is straining or coughing

Vaginal examination

Rectal examination

Differential diagnosis

Hypertrophy of the cervix

Tumours or cysts of the vagina

Tumours or cysts of the uterus

Inversion of the uterus

Management

Preventive

Active treatment ( surgical)

Vaginal procedures

Abdominal procedures

Combined procedures

Preventive Prophylactic measures - in childbirth -

- Avoidance of pushing at delivery, before the full dilatation of the cervix

- Avoidance of prolongation of the second stage of labor

- Avoidance of fundal pusching attempting to expel the placenta

- Careful repair in accurate layers of all vagina walls and perineal tears and incisions

- Early ambulation and pelvic floor exercices in the puerperinum